Jess McCabe

Latest feature: Are social landlords prepared for Ebola?

We’ve all been watching the rolling news coverage of the Ebola crisis. When we were considering what to run in Inside Housing’s health special, it seemed obvious to survey social landlords to see if they are planning on what they would do if a tenant or staff member caught Ebola: we found they are thinking about it, and have emergency plans in place. Here is the news write-off as well.

Ebola has killed thousands of people and caused widespread panic. But are social landlords considering what they would do if the worst occurred, and a tenant or staff member got sick? Jess McCabe reports

On 30 September, in Dallas, Texas, Thomas Eric Duncan was the first patient diagnosed with Ebola in the United States. Less than one week later, as his condition worsened, workers in Hazmat suits arrived in force and decontaminated the apartment where he had been staying.

According to news agency Associated Press, a few items were saved – including family photos – but most of the contents of his home, from children’s backpacks to carpets, were put into drums and incinerated.

Unforeseen impact

Now, state officials in Louisiana are fighting to prevent even the ashes being disposed of in landfill in the state.

Meanwhile, Mr Duncan’s bereaved fiancée and her family have been cleared of the haemorrhagic disease, which has caused widespread concern because it kills a high proportion of those who catch it, with a fatality rate of around 50%. But according to local press reports they are now homeless, and unable to find a landlord who is willing to rent them an apartment.

Such cases demonstrate that, although Ebola is first and foremost a medical emergency, there are consequences in terms of the disease – and the stigma attached to it – for both landlords and tenants.

But, given the high-profile concern about Ebola internationally, is it actually something that has caught the attention of housing providers in the UK too? Do they know what they would do if a tenant or a member of staff (or a member of their family) caught Ebola – or indeed for other similar risks?

To find out, Inside Housing sent out a straw poll survey to social landlords around the country. We asked if senior management has been having discussions about what to do in the event of an Ebola case – and more broadly about what contingency plans landlords have in place, how often they are updated and what sort of disasters are they preparing for (see box).

From the outset, it is important to keep the immediate threat posed by Ebola in perspective. The disease has killed nearly 5,000 people, according to the World Health Organization. However, at time of writing all but 10 of these were in West Africa. And not the whole of West Africa – the cases are mostly concentrated in Liberia, Guinea and Sierra Leone.

The actual risk of a case of Ebola in UK social housing is small. Only one Briton has, as of the beginning of November, caught the disease. The nurse William Pooley recovered and returned to work in Sierra Leone, treating other victims.

Given the potential seriousness, though, most of the landlords we spoke to had held some kind of discussion about the disease. Only five out of the 15 social landlords who responded to our straw poll said they hadn’t discussed what they would do if a staff member or tenant was affected.

In most cases, this has involved an informal discussion by senior management. However, some social landlords have taken a more thorough approach.

Catalyst Housing Group, for example, is one of the most prepared. Anthony Sewell, the 21,000-home landlord’s health, safety and wellbeing manager, says that it has an existing infection control policy ‘which we’ve reviewed in light of Ebola’. So what would it do if either a member of staff or a resident got Ebola?

‘While their absence would be dealt with by our normal sickness reporting procedures, it’s probable that some staff would respond to a colleague having Ebola by staying away from work, so as well as having a colleague (or colleagues) with Ebola, we may also face staff shortages,’ Mr Sewell says. Media interest in any cases would also be an issue, he notes.

‘If a resident was diagnosed with Ebola, this would be very distressing for them, their family, neighbours and any staff who have come into contact with them,’ he adds. ‘We have an infection control policy, which we’ve reviewed in light of Ebola. Initially, we would advise the resident to stay at home and dial 111 or 999 and to contact their GP. It’s probable that the authorities would want to keep them under observation – either in their own home or in an isolation unit in a hospital – so we would work closely with public health authorities if something awful like this actually happened and would keep their neighbours informed. We would also alert staff working in that area to see their GP if they have been in close contact with the resident or their family.’

The First Ark Group, which includes the 13,500-home Knowsley Housing Trust, is another landlord that has thought about its response. It tells us that discussions have taken place with its human resources department, its risk management team and other stakeholders – including its local council.

‘First Ark has a comprehensive group-wide business continuity plan, which covers any eventualities relating to outbreaks of disease or epidemics and we have agreed that this covers the actions we would take in the eventuality of a staff member being affected,’ the landlord says. The plan, which First Ark describes as ‘very comprehensive’, was last updated in January 2014.

Many landlords believe that a case would be covered by their existing plans that set out what to do if an infectious disease hits key staff, or in the case of a pandemic which could have a wider effect.

Walsall Housing Group, meanwhile, already has a two-page checklist for a flu epidemic, which it believes could be used as a ‘basis for action’.

Craig Daniel, assistant director of continuous improvement at Great Places Housing Group, adds: ‘Yes it has been discussed. We have a cross-departmental business continuity group which meets on a quarterly basis. We are satisfied that our pandemic response plan is sufficient but we are intending to revisit it at our next meeting early next month.’

Not everyone has discussed a specific plan, however. A spokesperson for Housing & Care 21, which falls into this category, points out: ‘In respect of Ebola and other infectious diseases and pandemics, the organisation considers information and guidance provided by third parties including the NHS and Care Quality Commission in responding to wide-scale adverse incidents. This ensures the response is proportionate and timely.’

No landlords told us that staff had raised specific concerns about the disease – although Anchor, which has a large business running care homes, acknowledges: ‘Our staff are aware of Ebola.’ The organisation has ‘comprehensive guidance on infection control in our role as a provider of care homes, care and support services’, a spokesperson for the landlord adds. It also has its eye on more humdrum infection risks – but ones which have a much greater chance of affecting staff and tenants. For example, Anchor offers its staff a voucher for a flu immunisation jab, as part of its efforts to control infections – in 2013, 2,000 of its staff members took advantage of the scheme.

Such is the sensitivity of the topic of Ebola, however, that not all landlords are comfortable with the discussion. Circle Housing, expressed disquiet about Inside Housing writing this feature, as it ‘could potentially stir up race issues for staff or tenants perceived to be from Africa’.

It is certainly true that there is no suggestion that landlords are panicking about Ebola – or any of the myriad of other risks, from pandemics to terrorism. But, understandably, most of the landlords who responded are prepared for the worst.

Ebola home protocols

If the worst happens, what advice is available? In the US, the Centres for Disease Control and Prevention has published detailed guidelines aimed at government officials and private companies confronted by having to decontaminate the home of someone who has caught Ebola.

According to the guidelines, if someone with Ebola has a fever, but has not been bleeding, had diarrhoea or vomiting, then the residents themselves can clean up the apartment. But if the other symptoms have developed, the clean-up should be handled by public health authorities or contract companies.

What should social landlords be doing?

Ebola is only the most recent and high-profile threat. It might just be the reminder that social landlords need to make sure their emergency planning is up to date. As Richard Wood, head of housing at risk management firm Zurich Municipal, puts it: ‘Fire, flood, striking workforce, outbreak of disease, loss of utilities and failure of subcontractors represent a dizzying array of potential disasters that could have a dramatic effect on the finances of any housing association.’

Risk experts say that social landlords should put in place a ‘business continuity plan’ that sets out what to do if an event occurs that might interrupt the organisation’s ability to continue. These plans take different forms, and have different levels of detail.

Richard Baines, director of sustainable development at Black Country Housing Group, notes there are strong business reasons for making sure tenants are protected in the case of something like a pandemic. ‘If we don’t protect our tenants, we are not protecting our incomes,’ Mr Baines notes. ‘If we don’t have tenants, we don’t exist.’

But just having a plan isn’t enough. They need to be regularly updated – at least annually, but more often if a material change takes place in the organisation, according to the ISO business continuity standard. All of the landlords who responded to our straw poll told us they do have a continuity plan in place. But not all of them have been updated this frequently – with landlords telling us they revisit their emergency planning anywhere from every three years, to every few months.

The plans come into play if a triggering incident occurs that would disrupt the running of the organisation. For example, the trigger might be a disease, or a pandemic, that would affect staff and human resources. But the plans should also cover incidents that affect premises, IT, key partners or suppliers, as well as key personnel.

Great Places Housing Group’s plan includes a page that looks at first glance like a bingo card. Actually, it’s a matrix of scenarios that Great Places has grouped together based on type (people, finance andtechnology, for example), and rated depending on the level of risk and potential to interrupt business-as-usual. Among the incidents that could have the biggest impact? Asbestos, fire, and a gas leak sit alongside an ‘Ujima-like occurrence’, referencing the collapse of the small housing association, or major computer virus causing all servers to crash.

Plans can be more or less complicated – a social landlord with a group structure may need several different plans, which come into play for an incident affecting a particular region, or a particular scheme.

And they need to be tested. Some landlords carry out role playing, or ‘tabletop’ exercises, to talk through the plans and identifying possible flaws. Mr Wood from Zurich Municipal explains: ‘Having a business continuity plan doesn’t always mean an association is a resilient one – plans have to be tested.

‘For example, a scenario based test, either in practice or in theory, is a useful way of supporting best practice as it permits the testing of people’s ability to react to an incident within a safe environment. It ensures employees have the correct skills and ability and are comfortable with discharging their duties during an incident. The net outcome being it gives an association assurance that its business continuity plans, its incident management team and its wider employees are prepared for and are capable of responding to an incident.’